When sight loss causes you to turn to drink

Post date: 
Friday, 20 March 2015

Many professionals are unsure how to treat clients with substance abuse problems and say they need more support, as Emily Wight reports

Optometrist Andrew Miller remembers clearly how, two years ago, a visually impaired client declared his alcoholism. 
“He admitted to losing contact with all his family,” Miller said. “But he told me that although he realised how important sight and family were, they were not as important as drink. He said he’d only come here because he’d been told to come here.”
Miller, optometry lead at Focus Birmingham, a local society that supports people with sight loss, insists it is important to have an open conversation with clients who may have an alcohol problem. 
His experience is not dissimilar to those shared in a new report by the Thomas Pocklington Trust and Alcohol Research UK, entitled “Alcohol, Other Drugs and Sight Loss: a Scoping Study”, which sheds a light on the complex relationship between sight loss and substance use. 
The report reviews existing data and international literature, and analyses primary interviews with visually impaired people and sight loss professionals.

More support needed

It reveals that many professionals are unsure how to treat clients with substance use problems and feel they could do with more support.
James Nicholls, Director of Research and Policy Development at Alcohol Research UK, which co-funded the report, said: “The report shows clearly that processes for identifying and supporting people with sight loss and substance use issues need to improve, and service providers need as much support as possible to achieve this. Hopefully, the findings will be a spur to the development of improved training across the board.”
According to Sarah Galvani, a professor at Manchester Metropolitan University and the University of Bedfordshire, who co-authored the report, professionals believe they lack training and knowledge in the field, and are also uncertain as to how involved they should get in clients’ personal lives. 
“It may be something that in the sight loss field hasn’t been considered a great deal, hasn’t been a priority for lots of valid reasons,” she said.
As well as touching on the ways in which alcohol misuse can cause sight loss, the study features individuals with sight loss who said they had started drinking to cope with their diagnosis – such as Sid, who said: “I think actually I do sit down and worry about my sight – then I have a beer and I don't worry.”
Using alcohol as a coping mechanism for sight loss is not surprising, said Galvani, as “people often use alcohol and drugs to cope with a whole range of problems in their lives”.
But many people might not realise this, she added. “It does send out a message that actually you need to think in terms of how to support people better when they’ve got sight loss and when they are drinking.”

Identifying the problems

So how can eye health professionals begin to identify these issues, and how should they act appropriately? 
It starts with not being afraid to ask questions about substance use, said Galvani. “You only ever get the answers to the questions that you ask.”
Alexis Horam, a rehab officer from Harrow, London, has encountered a wide spectrum of alcohol misuse. Over the past 20 years, she has worked closely with five clients who are alcoholics.
Did she ask them questions about their habits? “Absolutely. I believe as a rehab officer one of the great attributes you have is to be a really good listener and a really good communicator – it’s essential. I personally wouldn’t have a problem with asking a client anything.”
She also said it is crucial that she is non-judgmental: “I’m not there to put my own opinions onto situations,” she said.
“If someone is sitting day-in day-out in isolation in their own home, and they’re saying, I would like to go to a pub and I can’t do it, then as a rehab officer it’s my role to try and facilitate that safely.”
Miller has dealt with clients who have been drinking and he has, at times, been concerned for the safety of his staff. “We have had situations where I’ve felt uncomfortable putting some of my female optometrists with someone who’s not fully sober.”
He said that some clients tend to miss appointments due to drinking. “There are some frequent non-attendees and we know sometimes these are the people who may have some problems, and it does affect our costs, but we don’t strike patients off.”
He also believes it is crucial to talk with clients about their habits: “It’s something that I’m quite happy to have an open conversation about.”
Concern over drug or alcohol misuse should not come in the way of encouraging a client’s independence, stressed Galvani. With independence, she said, comes freedom of choice. “At the end of the day, we all have the capacity to choose and we all have the capacity to make bad decisions that aren’t good for us: we eat too much, we drink too much, we don’t do enough exercise. But we have the freedom to choose.”

Early intervention

How, then, might a professional support a client who needs training to go to the shop – even though that might mean risking safety by walking around drunk or buying a bottle of spirit rather than a pint of milk?
“The answer is to negotiate with that person – when is the best time to go? So it may be that the best time to go is earlier in the day so that they haven’t had too much to drink, or earlier in the week so they get their benefits the next day,” Galvani said.
She added that professionals across both sight loss and substance use sectors should work together. “It’s about having that inter-professional discussion,” she said, adding: “I think routine monitoring and screening both in sight loss and substance use services is a real starting point, otherwise we’re just waiting until it’s almost too late, and early intervention and harm reduction are out the window.”
After opening a dialogue with clients, what is the next step for sight loss professionals? Horam has referred clients to facilities in the area, be that the local authority team that deals with alcohol abuse or the voluntary sector. “I think a big part of our role is about empowering people with knowledge,” she said.

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